When I first had B12 checked I was at 120 then had weekly shot for 10 weeks. 2 weeks later bad blood test again and only at 300. The doctor says now monthly shots for the rest of my life. I am still very tired and my legs are still really fatigued. She says no anemia so I am confused as to why my body stopped absorbing B12?? She says this is just common and has no direction going forward except for monthly shots. I am not vegan and I do not have celiac. I do however have IBS. Do you think 300 is low. My doctor says it should be at a minimum of 450. I am so very confused and wondering if something else is going on with my body. I am scheduled for ultrasound and cytoscopy as they found microscopic blood in my urine.

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Most of your B12 is absorbed in the ileum - 99% - with 1% being absorbed in the rest of the gut. IBS could be a pointer - potentially indicating that you have low stomach acidity - one cause of a B12 deficiency. Other are PA - autoimmune response, gastric surgery affecting the ileum, genetic factors leading to abnormalities in the ileum and a whole raft of drug interactions - ironically including many drugs that are used to treat symptoms of a B12 deficiency so just make the situation worse.

People vary a lot in how they absorb and process B12 - 300 does sound low if you are on regular injections. But 450 is also an arbitrary figure for where things should be.

The symptoms of B12 deficiency are not caused by anaemia - anaemia is one consequence of a B12 deficiency, that may lead to some other symptoms but as B12 is also used by a number of systems in the body even the symptoms associated with anaemia may be caused by other interactions.

A lot of people develop neurological problems long before any obvious anaemia develops.

Do you know what your Folate levels are as B9 (folic acid" works "hand in hand" with b12 and is essential.

Folates can be obtained naturally through leafy green vegetables such as spinach, broccoli, sprouts etc but cannot be stored in the body. Folic acid can also be found "added" to various cereals or over the counter supplements.

I am not a medically qualified person and there are others in this community able to give expert advice.